Mentally Ill at Risk in County Jails, Study Says

A panel of medical experts retained by the U.S. Department of Justice has issued a scathing report accusing Los Angeles County of providing woefully inadequate--if not downright dangerous--care to mentally ill inmates in the county jails.

Providing a sobering glimpse into the county’s deteriorating jail system, the panel has assailed the Sheriff’s Department and county mental health officials for housing scores of mentally ill inmates in cramped, dingy cells where they receive little treatment. The inmates are locked up almost continuously, the independent panel found, having little access to exercise yards or day rooms. Even showers are infrequent, according to the report prepared by the team hired by the Justice Department’s Civil Rights Division.

What’s more, the panel wrote, some prisoners languish for days and even weeks without the medication they desperately need to keep their illnesses under control, while other mentally ill prisoners are given drugs--such as lithium and Depakote--to treat conditions from which they might not suffer.

“A discharge from mental health housing may be the only way to improve an inmate’s mental health,” according to the panel of mental health experts, which included two doctors. Panel members, through the Department of Justice, declined to comment.

County Mental Health Director Areta Crowell--whose department provides treatment to about 1,600 inmates in the jails--said she believed that some of the findings in the report were “exaggerated,” but she acknowledged that there are significant problems.

As a result, sheriff’s and mental health officials are taking steps to try to rectify the situation, Crowell said, adding that she will seek an $8-million-a-year budget boost for next fiscal year from the county Board of Supervisors to double the mental health staff in the jails to nearly 200 positions.

“We have given the issues very serious attention,” Crowell said. “We would hope that [the Department of Justice] would understand that there is a tremendous amount of work going into improving the situation.”

“We’re moving in the right direction,” said Sheriff’s Department custody chief Barry King, one of about half a dozen sheriff’s administrators assigned to the jail system during the past six months to try to remedy its problems.

The Department of Justice--which commissioned the independent study last year amid complaints that the civil rights of mentally ill inmates were being violated--is expected to issue a list of findings and recommendations within the next few weeks. In the meantime, Department of Justice officials, who said the report is based upon the experts’ tour of the jails and does not necessarily reflect the views of the department, have declined to comment on the investigation.

The tightly held federal report--which has yet to be made public but was obtained by The Times--underscores the crisis that has plagued the county lockups in recent months.

Overcrowding throughout the jail system has reached its worst level in years, with inmates sleeping on the floors, in the mess halls and in the chapels, prompting the threat of a lawsuit from the American Civil Liberties Union.

While inmate advocacy groups say living conditions are bad for inmates in the general population, it is worse, they say, for the mentally ill, who are kept in small, poorly lit cellblocks--referred to by sheriff’s deputies as the “ding tanks.”

“We observed cell after cell crowded with inmates who were psychotic or severely depressed and getting worse,” the report said.

Among the problems outlined in the report:

* Jail medical records are often incomplete and illegible. “The lack of an adequate computer system by which to conduct jail operations greatly hampers the operation of a jail that books over 200,000 offenders annually and has a daily population in excess of 19,000,” the experts wrote.

They said they were surprised to find that the county maintains separate medical charts--kept at various jail facilities--making it necessary to look at several records in order to find answers to basic questions such as why an individual was restrained. In addition, the pharmacy does not have the computer capability to issue a list of inmates taking psychotropic medications, leading to dangerous lapses in treatment. And in some cases, inmates were placed on psychotropic medications, even though their charts gave little documentation showing that they needed the drugs.

“It is sometimes impossible to tell from the charts whether an individual has been properly medicated,” the report stated.

* Identification of mentally ill inmates during the booking process is deficient. Mental health personnel admitted to investigators that little or no effort is made to treat the mentally ill inmates who are not “high impact” or actively suicidal. “Inmates who are profoundly but quietly depressed, or turning inward into a terrifying world of psychotic voices, will receive no assistance,” the experts wrote.

* Inmates are housed in cells so inadequate that the conditions only exacerbate their illnesses. At Sybil Brand Institute--where 465 women are receiving mental health services--inmates are placed in triple bunks, leaving the bottom two beds with a very, very small amount of headroom. Furthermore, “the beds were only approximately 16 inches apart, side-to-side,” experts wrote.

* Suicide cells are often not safe for the suicidal. “We observed some clearly dangerous conditions in the suicide dorm area [at Sybil Brand], including standing water, a toxic substance left on the sink [Clorox] and protruding bars from old pipes,” the experts wrote.

* Mentally ill inmates are often kept in jail after an offense for which a non-mentally ill individual would simply be cited and released. “Not only does this appear to be a blatant exhibition of discrimination against mentally ill persons, but it increases crowding in the jails, with no apparent benefit,” the report said.

* Inmates are also denied basic privileges given to other prisoners. At the North County Correctional Facility, for example, no inmates on medication are allowed to participate in jail work programs. “Inmates in mental health housing told us that they are not allowed even to go to the library,” according to the report. “They only receive one hour per week of yard time. . . . Yet inmates and staff report that yard time is available several hours per day for each dormitory.”

* Mentally ill inmates--who are dressed in yellow fatigues to identify their condition--are subjected to verbal and physical abuse by inmate trusties. “The jail appears to be attempting to compensate for inadequate staffing by using inmate trusties,” the report said. “It is our opinion that the use of inmate trusties to compensate for inadequate staffing is unacceptable. We were informed of serious allegations that inmate trusties abuse their charges.” Investigators were still seeking information about the alleged abuse at the time they wrote the report.

In conclusion, the experts said that they held little hope that the situation could be remedied without “significant increases in staffing, reorganization of the administrative structure and an improved system of medical records.”

“Overall, there is no doubt that the [Los Angeles County Sheriff’s Department] falls significantly below its duty to provide the minimal treatment necessary for inmates with serious psychiatric illness,” the report said.

It is a sentiment that has been echoed in the past by Merrick Bobb, special counsel to the Board of Supervisors studying problems at the Sheriff’s Department.

“I have said that the system for identifying sick inmates and providing medical service is flawed, and, as is apparent from the Department of Justice study, there have been deeply troubling problems in the care of mentally disturbed inmates,” Bobb said.

Bobb suggested county mental health officials increase the staffing of mental health workers and improve the drug prescription and delivery system to better manage the care of mentally ill inmates.

The Department of Justice probe began last summer as a result of “complaints from individuals and public interest organizations,” according to a letter sent to the county by U.S. Assistant Atty. Gen. Deval L. Patrick. “The purpose of the investigation is to determine whether conditions in the jail system violate the constitutional rights of its inmates.”

In May, the county approved a $2.5-million settlement for a mentally ill man who was released from jail and, disoriented, was crippled when he wandered into the path of a train.

County officials admit that the man, William Penuela, was grievously mistreated by employees of the Sheriff’s Department and the mental health department after his arrest in 1991 on suspicion of vandalizing a Glendale church. For two weeks, he languished in a county jail without the medication his family said he needed to keep his paranoid schizophrenia under control.

Then, despite his family’s pleas that they be notified before he was released, Penuela was let out of jail on the evening of March 1, 1991, penniless and alone. In a state of paranoid delusion, according to court documents, he wandered into the path of a train, which crippled him for life.

Over the past few weeks, jail officials said they have been moving ahead with efforts to correct the problems, including closely monitoring the trusties’ contact with mentally ill inmates and expanding training of deputies who come in contact with mentally ill inmates.

The Sheriff’s Department is also taking steps to automate its medical records system. “The automation will certainly be the crown jewel in our effort to solve all of these problems,” said King.

Despite the criticism, jail and mental health officials say they can solve the problems with enough resources.

“I take our treatment very seriously,” Crowell said. “Our entire mental health system is underfunded, so it is not surprising that the jail’s mental health system is underfunded. All I can say is we have done the best we could with what we had.”